1
|
Hajek A, König HH, Sutin AR, Terracciano A, Luchetti M, Stephan Y, Gyasi RM. Prevalence and factors associated with probable depression among the oldest old during the Covid-19 pandemic: evidence from the large, nationally representative 'Old Age in Germany (D80+)' study. Psychogeriatrics 2024; 24:838-846. [PMID: 38699978 DOI: 10.1111/psyg.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/09/2024] [Accepted: 04/21/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND To date, most studies examining the prevalence and determinants of depression among individuals aged 80 and over have used geographically limited samples that are not generalisable to the wider population. Thus, our aim was to identify the prevalence and the factors associated with probable depression among the oldest old in Germany based on nationally representative data. METHODS Data were taken from the nationally representative 'Old Age in Germany (D80+)' study (n = 8386; November 2020 to April 2021) covering both community-dwelling and institutionalised individuals aged 80 and over. The Short Form of the Depression in Old Age Scale was used to quantify probable depression. RESULTS Probable depression was found in 40.7% (95% CI: 39.5% to 42.0%) of the sample; 31.3% were men (95% CI: 29.7% to 32.9%) and 46.6% women (95% CI: 44.9% to 48.3%). The odds of probable depression were positively associated with being female (odds ratio (OR): 1.55, 95% CI: 1.30 to 1.84), being divorced (compared to being married, OR: 1.33, 95% CI: 1.01 to 1.76), being widowed (OR: 1.14, 95% CI: 1.00 to 1.30), having a low education (e.g., medium education compared to low education, OR: 0.86, 95% CI: 0.74 to 0.99), living in an institutionalised setting (OR: 2.36, 95% CI: 1.84 to 3.02), living in East Germany (OR: 1.21, 95% CI, 1.05 to 1.39), not having German citizenship (German citizenship compared to other citizenship, OR: 0.55, 95% CI: 0.31 to 0.95), poor self-rated health (OR: 0.31, 95% CI: 0.28 to 0.34), and the number of chronic conditions (OR: 1.12, 95% CI: 1.09 to 1.14). CONCLUSION About four out of 10 individuals aged 80 and over in Germany had probable depression, underlining the importance of this challenge. Knowledge of specific risk factors for this age group may assist in addressing older adults at risk of probable depression.
Collapse
Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Angelina R Sutin
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | | | - Martina Luchetti
- College of Medicine, Florida State University, Tallahassee, Florida, USA
| | | | - Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
| |
Collapse
|
2
|
Chen Y, Feng F, Li Q, Guo H, Zhang L, Liu J. Frailty index and risk of delirium in hospitalized patients: a two-sample Mendelian randomization study. Front Med (Lausanne) 2024; 11:1361437. [PMID: 38841572 PMCID: PMC11150602 DOI: 10.3389/fmed.2024.1361437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
Objective Observational studies suggest that the frailty index (FI) is closely related to delirium, but the relationship between them is still uncertain due to the influence of various confounding factors. Therefore, two-sample Mendelian randomization (MR) was used to explore the causal relationship between the FI and delirium risk. Methods This study obtained pooled statistics for the FI and delirium from two of the most extensive genome-wide association studies. To make the results more robust and reliable, supplementary analyses were performed using several robust analytical methods (inverse-variance weighting, MR-Egger regression, and weighted median). In addition, this study used the MR-Egger intercept test, Cochran's Q test, funnel plots and the leave-one-out method to evaluate the pleiotropy and heterogeneity among the abovementioned genetic variation instrumental variables. Results Frailty might increase the relative risk of delirium, as shown by IVW (OR = 1.849, 95% CI 0.027∼2.067, P = 0.044), weighted median (OR = 1.726, 95% CI -0.178∼2.664, P = 0.083), MR-Egger regression (OR = 1.768, 95% CI -3.08∼6.171, P = 0.525) and leave-one-out sensitivity analysis (P = 0.058). Although the WME method and MR-Egger regression analysis showed no statistically significant causal relationship between the FI and the risk of delirium, the direction of the causal effect was consistent with the IVW method. Conclusion There is a notable correlation between a higher FI and an elevated risk of delirium. This indicates that healthcare providers should take proactive measures to prevent delirium in hospitalized patients with a higher FI.
Collapse
Affiliation(s)
- Yu Chen
- Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Fang Feng
- Intensive Care Unit, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Qun Li
- Intensive Care Unit, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Hong Guo
- Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Lu Zhang
- Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jian Liu
- Intensive Care Unit, The First School of Clinical Medicine of Lanzhou University, Lanzhou, Gansu, China
- Intensive Care Unit, Gansu Provincial Central Hospital, Lanzhou, Gansu, China
| |
Collapse
|
3
|
Lin FF, Yang WY, Zhou JX, Cao LY, Huang LL. Retrospective Investigation and Research on Fall Events Among Hospitalized Patients in the Rehabilitation Department. Risk Manag Healthc Policy 2024; 17:1069-1078. [PMID: 38699655 PMCID: PMC11063461 DOI: 10.2147/rmhp.s445808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Objective We investigated the clinical characteristics, fall outcomes, and related factors of falls in patients who were hospitalized in the rehabilitation department, and explored strategies to reduce the incidence of falls and prevent falls in patients. Methods Data from 60 patients who fell in the rehabilitation department between 2016 and 2021 were analyzed for clinical characteristics, associated factors, incidence of falls, injuries, and patient demographics. Under the random stratified sampling method, 60 patients who did not fall during the same period were selected as the control group, and relevant data was collected. Measurement data were compared using an independent sample t-test. Enumeration data were compared using chi-squared (χ2) test was employed to compare these data between the two groups. Non-parametric data were analyzed using the Mann-Whitney U-test. Factors potentially influencing falls were scrutinized through both univariate and binary logistic regression analyses. Results The median annual incidence of falls among patients who were hospitalized in the rehabilitation department was 0.04%, while the overall fall injury rate was 60%. Falls were most prevalent within 30 days of hospitalization (71.67%). The most common fall-related condition was craniocerebral disease (83.33%). The incidents of falls location of fall were mainly reported in nearby areas of rehabilitation ward (70%). Most accidents occurred between 7:00 a.m.-12:00 p.m. and 3:01 p.m.-6:00 p.m. (63.33%), and dyskinesia was the most common cause of falls (71.67%). There were 39 patients (65.00%) with Barthel Index (BI) scores ranging between 40-60. Conclusion Patients in the rehabilitation department had a greater incidence of falls and fall injuries. Within 30 days of admission, patients with moderately dependent craniocerebral disorders and dyskinesia frequently experienced falls during typical daytime shifts in areas characterized by endemic conditions.
Collapse
Affiliation(s)
- Fang-Fang Lin
- Department of Rehabilitation, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352000, People’s Republic of China
| | - Wei-Yuan Yang
- Department of Rehabilitation, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352000, People’s Republic of China
| | - Jun-Xiang Zhou
- Department of Rehabilitation, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352000, People’s Republic of China
| | - Luo-Yuan Cao
- Department of Central Laboratory, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352000, People’s Republic of China
| | - Ling-Ling Huang
- Department of Rehabilitation, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, 352000, People’s Republic of China
| |
Collapse
|
4
|
Bålsrud P, Ulven SM, Christensen JJ, Ottestad I, Holven KB. Inflammatory markers and frailty in home-dwelling elderly, a cross-sectional study. BMC Geriatr 2024; 24:175. [PMID: 38373890 PMCID: PMC10877806 DOI: 10.1186/s12877-024-04690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Low-grade, chronic inflammation during ageing, ("inflammageing"), is suggested to be involved in the development of frailty in older age. However, studies on the association between frailty, using the frailty index definition, and inflammatory markers are limited. The aim of this study was to investigate the relationship between inflammatory markers and frailty index (FI) in older, home-dwelling adults. METHOD Home-dwelling men and women aged ≥ 70 years old, living in South-East Norway were recruited and included in a cross-sectional study. The FI used in the current study was developed according to Rockwood's frailty index and included 38 variables, resulting in an FI score between 0 and 1 for each participant. Circulating inflammatory markers (IL-6, CRP, IGF-1, cystatin C, cathepsin S, and glycoprotein Acetyls) were analyzed from non-fasting blood samples using ELISA. Whole-genome PBMC transcriptomics was used to study the association between FI score and inflammation. RESULTS The study population comprised 403 elderly (52% women), with a median age of 74 years and a mean BMI of 26.2 kg/m2. The mean FI score for the total group was 0.15 (range 0.005-0.56). The group was divided into a frail group (FI score ≥ 0.25) and non-frail group. After adjusting for BMI, age, sex, and smoking in the whole group, IL-6, cathepsin S, cystatin C, and Gp-acetyls remained significant associated to FI score (IL-6: 0.002, 95% CI: 0.001, 0.002, cathepsin S: 6.7e-06, 95% CI 2.44e-06, 0.00001, cystatin C: 0.004, 95% CI: 0.002, 0.006, Gp- Acetyls: 0.09, 95% CI: 0.05, 0.13, p < 0.01 for all), while CRP and IGF-1 were not (0.0003, 95% CI: -00001, 0.0007, p = 0.13, (-1.27e-06), 95% CI: (-0.0003), 0.0003, p = 0.99). There was a significant association between FI score and inflammatory markers, and FI score and monocyte-specific gene expression. CONCLUSIONS We found an association between FI score and inflammatory markers, and between FI score and monocyte-specific gene expression among elderly subjects above 70 years of age. Whether inflammation is a cause or consequence of frailty and whether the progression of frailty can be attenuated by reducing inflammation remains to be clarified.
Collapse
Affiliation(s)
- Pia Bålsrud
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Stine M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jacob J Christensen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Clinical Nutrition, Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
- National Advisory Unit on FH, Oslo University Hospital, Oslo, Norway.
| |
Collapse
|
5
|
Rankin L, Lindkvist M, Backman A, Sköldunger A, Lövheim H, Edvardsson D, Gustafsson M. Pharmacological treatment of pain in Swedish nursing homes: Prevalence and associations with cognitive impairment and depressive mood. Scand J Pain 2024; 24:sjpain-2024-0007. [PMID: 38887790 DOI: 10.1515/sjpain-2024-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/15/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Chronic pain is highly prevalent in nursing home residents and often occurs with depression as well as cognitive impairment, which can severely influence and limit the expression of pain. METHODS The present cross-sectional study aimed to estimate the prevalence of pain, depressive mood, and cognitive impairment in association with pharmacological treatment against pain and depressive symptoms among Swedish nursing home residents. RESULTS We found an overall pain prevalence of 52.8%, a prevalence of 63.1% for being in a depressive mood, and a prevalence of cognitive impairment of 68.3%. Among individuals assessed to have depressive mood, 60.5% were also assessed to have pain. The prevalence of pharmacological treatment for pain was 77.5 and 54.1% for antidepressants. Prescription of pharmacological treatment against pain was associated with reports of currently having pain, and paracetamol was the most prescribed drug. A higher cognitive function was associated with more filled prescriptions of drugs for neuropathic pain, paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs), which could indicate an undertreatment of pain in those cognitively impaired. CONCLUSION It is important to further explore the relationship between pain, depressive mood, and cognitive impairment in regard to pain management in nursing home residents.
Collapse
Affiliation(s)
- Linda Rankin
- Department of Medical and Translational Biology, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | | | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia; Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Maria Gustafsson
- Department of Medical and Translational Biology, Umeå University, Umeå, Sweden
| |
Collapse
|
6
|
Isernia S, Blasi V, Baglio G, Cabinio M, Cecconi P, Rossetto F, Cazzoli M, Blasi F, Bruckmann C, Giunco F, Sorbi S, Clerici M, Baglio F. The key role of depression and supramarginal gyrus in frailty: a cross-sectional study. Front Aging Neurosci 2023; 15:1292417. [PMID: 38020757 PMCID: PMC10665836 DOI: 10.3389/fnagi.2023.1292417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background The age-related decrease in reserve and resistance to stressors is recognized as frailty, one of the most significant challenges identified in recent years. Despite a well-acknowledged association of frailty with cognitive impairment, depression, and gray matter morphology, no clear data are available regarding the nature of this relationship. This cross-sectional study aims to disentangle the role of the behavioral, neuropsychological, and neural components as predictors or moderators of frailty. Methods Ninety-six older adults (mean age = 75.49 ± 6.62) were consecutively enrolled and underwent a clinical and MRI (3 T) evaluation to assess frailty, physical activity, global cognitive level, depression, wellbeing, autonomy in daily living, cortical thickness, and subcortical volumes. Results Results showed a full mediation of depression on the link between cortical thickness and frailty, while the cognitive level showed no significant mediating role. In particular, left supramarginal thickness had a predicting role on depression, that in turn impacted frailty occurrence. Finally, handgrip weakness was an early key indicator of frailty in this study's cohort. Conclusion These data substantiate the role of depression in mediating the link between neural integrity of the supramarginal gyrus and frailty. In the complexity of frailty, handgrip weakness seems to be an early key indicator. These results are relevant for the design of rehabilitation interventions aimed at reversing the frail condition.
Collapse
Affiliation(s)
- Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | - Marta Cazzoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Francesco Blasi
- Fondazione Istituto FIRC di Oncologia Molecolare, Milan, Italy
| | | | | | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | |
Collapse
|
7
|
Matos Queirós A, von Gunten A, Rosselet Amoussou J, Martins MM, Verloo H. Relationship Between Depression and Falls Among Nursing Home Residents: Protocol for an Integrative Review. JMIR Res Protoc 2023; 12:e46995. [PMID: 37856175 PMCID: PMC10623236 DOI: 10.2196/46995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Aging exposes individuals to new health disorders and debilitating chronic diseases, yet most older adults, even in functional decline, do not want to leave their homes. Nevertheless, for many, institutionalization in a nursing home (NH) may become essential to ensure their continued safety and health. Depression is one of the most common psychiatric disorders among older adults, especially among those who are institutionalized. Depressed NH residents face a high risk of future functional decline and falls, decreasing their quality of life. The relationship between depression and falls is complex and bidirectional. Previous reviews have focused on home-dwelling older adults or explored the relationship between antidepressant drugs and falls. To the best of our knowledge, no integrative literature reviews have explored the relationship between depression and falls among NH residents. OBJECTIVE Analyze studies on the relationship between depression and falls among NH residents. METHODS We will conduct an integrative literature review of published articles in relevant scientific journals on the relationship between depression and depressive symptomatology and falls among NH residents. As usually defined, we will consider NH residents to be people aged 65 years and older who can no longer live safely and independently in their homes. We will also consider older adults on short-term stays in an NH for rehabilitation after hospital discharge. Retrieved articles will be screened for eligibility and analyzed following previously reported steps. The most pertinent bibliographical databases will be examined for qualitative, quantitative, and mixed methods studies, from inception until August 31, 2023, thus ensuring that all relevant literature is included. We will also hand-search the bibliographies of all the relevant articles found and search for unpublished studies in any language. If appropriate, we will consider conducting a meta-analysis of the studies retrieved. RESULTS A first round of data collection was completed in March 2023. We retrieved a total of 2276 references. A supplementary literature search to ensure the most up-to-date evidence is ongoing. We anticipate that the review will be completed in late September 2023, and we expect to publish results at the end of December 2023. CONCLUSIONS This integrative review will increase knowledge and understanding of the complex relationship between depression and falls in NH environments. Its findings will be important for developing integrated, multidisciplinary models and care recommendations, adaptable to each NH resident's situation and health status, and for creating preventive interventions to help them maintain or recover optimal health stability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46995.
Collapse
Affiliation(s)
- Alcina Matos Queirós
- Department of Health and Social Welfare, University of Lausanne, Lausanne, Switzerland
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joëlle Rosselet Amoussou
- Medical Library-Cery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Henk Verloo
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- School of Nursing Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland
| |
Collapse
|
8
|
Boustany A, Onwuzo S, Zeid HKA, Almomani A, Asaad I. ANTIDEPRESSANT MEDICATIONS ARE ASSOCIATED WITH INCREASED RISK OF HOSPITAL-ACQUIRED CLOSTRIDIOIDES DIFFICILE INFECTION: A POPULATION-BASED STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:309-314. [PMID: 37792759 DOI: 10.1590/s0004-2803.230302023-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/20/2023] [Indexed: 10/06/2023]
Abstract
WHAT IS ALREADY KNOWN •The rate and severity of Clostridioides difficile infection (CDI) has increased throughout North America, the United Kingdom, and Europe. •Scattered evidence about the association of CDI with antidepressant medications use exists in the literature so far. What are the new findings: •The risk of Clostridioides difficile infection is higher in patients who are on mirtazapine, nortriptyline, or trazodone. •The prevalence rate of Clostridioides difficile infection in patients who were using antidepressant medications and the ones who did not, increased with age. Background - During the past decade, Clostridioides difficile infection (CDI) has become the most common cause of antibiotic-associated diarrhea. Several risk factors have been implicated. Scattered evidence about the association of CDI with antidepressant medications use exists in the literature so far. Therefore, we aim to investigate whether the risk of developing CDI is increased in hospitalized patients using antidepressant medications.Methods - Patients who were hospitalized were included in our cohort. We excluded individuals aged less than 18 years. A multivariate regression analysis was performed to calculate the risk of CDI accounting for potential confounders. Results - The risk of CDI in hospitalized patients was increased in individuals diagnosed with inflammatory bowel disease (OR: 4.44; 95%CI: 4.35-4.52), and in patients using clindamycin (OR: 1.55; 95%CI: 1.53-1.57), beta-lactam antibiotics (OR: 1.62; 95%CI: 1.60-1.64), PPI (OR: 3.27; 95%CI: 3.23-3.30), trazodone (OR: 1.31; 95%CI: 1.29-1.33), nortriptyline (OR: 1.25; 95%CI: 1.21-1.28), and mirtazapine (OR: 2.50; 95%CI: 2.46-2.54). After controlling for covariates, the risk of CDI was not increased in patients who were taking fluoxetine (OR: 0.94; 95%CI: 0.92-0.96). Conclusion - In contrary to fluoxetine; mirtazapine, nortriptyline, and trazodone were associated with increased risk of CDI in hospitalized patients.
Collapse
Affiliation(s)
- Antoine Boustany
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Somtochukwu Onwuzo
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | | | - Ashraf Almomani
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Imad Asaad
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| |
Collapse
|
9
|
Borkent J, Manders M, Nijhof A, Wijker L, Feskens E, Naumann E, de van der Schueren M. Too low protein and energy intake in nursing homes residents. Nutrition 2023; 110:112005. [PMID: 36966585 DOI: 10.1016/j.nut.2023.112005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES An optimal diet contributes to reducing malnutrition prevalence in the nursing home population. For this population, recommended daily intakes are ≥1.0 g protein/kg body weight and ≥27 energy kcal/kg body weight. The aim of this study was to identify the protein and energy intake of nursing home residents and to assess groups at increased risk for low intake. METHODS Cross-sectional data regarding food intake was collected by three-day observations in 189 residents (aged ≥65 y, mean age 85.0 y) of five different nursing homes. Linear mixed models were used to examine associations of protein and energy intake as dependent variables with demographic and disease-related problems as determinants. Results were adjusted for age, sex, and mobility levels and stratified by a protein/energy-enriched diet (P/E+). RESULTS The daily protein intake of the residents was 0.80 (SD 0.22) g/kg body weight, with 84.7% having an intake below the recommended daily 1 g/kg body weight. Mean daily energy intake was 20.7 (SD 6.1) kcal/kg body weight, with 85.2% having an intake below recommendation. Protein/energy intake was higher in the P/E+ group compared with standard diet: 0.92 (SD 0.23) versus 0.74 (SD 0.19) g/kg body weight, and 23.9 (SD 6.1) versus 19.1 (SD 5.4) kcal/kg body weight, respectively. The oldest age groups (>85 y), chair-bound residents, women, and residents having difficulties with chewing, dysphagia, a reported decreased food intake, or a decreased appetite were at a higher risk for a low protein/energy intake. CONCLUSION Nearly all nursing home residents were at increased risk for not meeting the minimum protein/energy requirements. Intakes should, on average, be increased with ≥15 g protein and ≥520 kcal to reach the minimum intake targets. Although using a P/E+ diet was associated with higher intakes, even these residents had intakes below the requirements.
Collapse
|
10
|
Coin A, Noale M, Gareri P, Trevisan C, Bellio A, Fini F, Abbatecola AM, Del Signore S, Malara A, Mossello E, Fumagalli S, Volpato S, Monzani F, Bellelli G, Zia G, Incalzi RA. Clinical profile of trazodone users in a multisetting older population: data from the Italian GeroCovid Observational study. Eur Geriatr Med 2023:10.1007/s41999-023-00790-1. [PMID: 37204681 DOI: 10.1007/s41999-023-00790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/19/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Depression is highly prevalent in older adults, especially in those with dementia. Trazodone, an antidepressant, has shown to be effective in older patients with moderate anxiolytic and hypnotic activity; and a common off-label use is rising for managing behavioral and psychological symptoms of dementia (BPSD). The aim of the study is to comparatively assess the clinical profiles of older patients treated with trazodone or other antidepressants. METHODS This cross-sectional study involved adults aged ≥ 60 years at risk of or affected with COVID-19 enrolled in the GeroCovid Observational study from acute wards, geriatric and dementia-specific outpatient clinics, as well as long-term care facilities (LTCF). Participants were grouped according to the use of trazodone, other antidepressants, or no antidepressant use. RESULTS Of the 3396 study participants (mean age 80.6 ± 9.1 years; 57.1% females), 10.8% used trazodone and 8.5% others antidepressants. Individuals treated with trazodone were older, more functionally dependent, and had a higher prevalence of dementia and BPSD than those using other antidepressants or no antidepressant use. Logistic regression analyses found that the presence of BPSD was associated with trazodone use (odds ratio (OR) 28.4, 95% confidence interval (CI) 18-44.7 for the outcome trazodone vs no antidepressants use, among participants without depression; OR 2.17, 95% CI 1.05-4.49 for the outcome trazodone vs no antidepressants use, among participants with depression). A cluster analysis of trazodone use identified three clusters: cluster 1 included mainly women, living at home with assistance, multimorbidity, dementia, BPSD, and depression; cluster 2 included mainly institutionalized women, with disabilities, depression, and dementia; cluster 3 included mostly men, often living at home unassisted, with better mobility performance, fewer chronic diseases, dementia, BPSD, and depression. DISCUSSION The use of trazodone was highly prevalent in functionally dependent and comorbid older adults admitted to LTCF or living at home. Clinical conditions associated with its prescription included depression as well as BPSD.
Collapse
Affiliation(s)
- Alessandra Coin
- Geriatrics Unit, Azienda Ospedale Università di Padova, Department of Medicine (DIMED), University of Padova, Via N. Giustiniani 2, 35128, Padua, Italy.
| | - Marianna Noale
- Neuroscience Institute, National Research Council (CNR), Aging Branch, Padua, Italy
| | - Pietro Gareri
- Center for Cognitive Disorders and Dementia-Catanzaro Lido, ASP Catanzaro, Catanzaro, Italy
| | - Caterina Trevisan
- Geriatrics Unit, Azienda Ospedale Università di Padova, Department of Medicine (DIMED), University of Padova, Via N. Giustiniani 2, 35128, Padua, Italy
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Andrea Bellio
- Geriatrics Unit, Azienda Ospedale Università di Padova, Department of Medicine (DIMED), University of Padova, Via N. Giustiniani 2, 35128, Padua, Italy
| | - Filippo Fini
- Geriatrics Unit, Azienda Ospedale Università di Padova, Department of Medicine (DIMED), University of Padova, Via N. Giustiniani 2, 35128, Padua, Italy
| | | | | | | | - Enrico Mossello
- Geriatric Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Stefano Fumagalli
- Geriatric Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Stefano Volpato
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Fabio Monzani
- Intermediate Care Unit, Nursing Home Misericordia, Navacchio, Pisa, Italy
| | - Giuseppe Bellelli
- Acute Geriatric Unit, IRCCS Foundation San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| |
Collapse
|
11
|
Trends, Patterns and Associated User Characteristics of Antidepressant Prescriptions in Older Adults: A Nationwide Descriptive Cohort Study in Denmark. Drugs Aging 2023; 40:355-368. [PMID: 36920735 DOI: 10.1007/s40266-023-01018-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Antidepressant use in older adults (≥ 65 years) is understudied in large population-based samples, particularly in recent years and regarding user characteristics. We aimed to describe the trends, patterns, and associated user characteristics of all antidepressant prescriptions redeemed by older adults at community pharmacies in Denmark during 2015-2019. METHODS This register-based study used a cross-sectional design to characterize antidepressant prescription trends and patterns, and a cohort design to describe user characteristics associated with antidepressant prescription initiation. We used descriptive statistics to characterize trends and patterns, and Poisson regression for analyzing user characteristics. RESULTS During the years 2015-2019, 17.9% of 1.2 million older adults redeemed 4.84 million antidepressant prescriptions, where 48.5% were selective serotonin reuptake inhibitors, followed by noradrenergic and specific serotonergic antidepressants (26.2%), serotonin-norepinephrine reuptake inhibitors (12.7%), tricyclic antidepressants (11.2%), and others (1.4%). Amitriptyline and nortriptyline, considered potentially inappropriate medications, were among the 10 most frequently redeemed antidepressants. Only 60.5% of prescriptions had a treatment indication of depression. Prescription-proportion trends by drug classes and individual antidepressants remained consistent. A higher incidence rate ratio (IRR) and 95% confidence interval (CI) of initiating antidepressants was associated with female sex (IRR 1.20, 95% CI 1.07-1.34), older age (e.g., 81-85 years vs. 65-70 years: IRR 1.74, 95% CI 1.44-2.11), living in rural areas (North Denmark vs. Capital Region: IRR 1.31, 95% CI 1.09-1.58), and having somatic and psychiatric diagnoses (e.g., per one psychiatric diagnosis: IRR 1.10, 95% CI 1.05-1.15), while a lower ratio was associated with being non-Western (vs. Danish: IRR 0.50, 95% CI 0.28-0.89) and having hospital contacts for psychiatric treatment (per each contact: IRR 0.96, 95% CI 0.93-1.00). CONCLUSION SSRIs were the most commonly redeemed antidepressants, with consistent trends in Danish older adults. Besides clinical conditions, sociodemographics, e.g., sex, age, ethnicity, and place of residence, may influence antidepressant use.
Collapse
|
12
|
Evaluation of Selected Parameters of Oxidative Stress and Adipokine Levels in Hospitalized Older Patients with Diverse Nutritional Status. Antioxidants (Basel) 2023; 12:antiox12030569. [PMID: 36978817 PMCID: PMC10044703 DOI: 10.3390/antiox12030569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
Malnutrition is classified as one of the Giant Geriatric Syndromes. It carries serious consequences, such as sarcopenia or depression, which lead to functional disability. The main objective of this study was to identify parameters of oxidative stress and adipokines, which may be potential biomarkers of malnutrition in hospitalized older patients. During the study, selected parameters were determined in 137 senile patients, taking into account their nutritional status determined according to the Mini Nutritional Assessment (MNA), as well as an additional tool, namely the Geriatric Nutritional Risk Index (GNRI). Leptin and resistin were determined as the parameters with statistically significant differences between the patients classified according to the MNA. This phenomenon was confirmed using the GNRI classification. However, additional parameters for which differences were observed include the oxidized low-density lipoprotein level and activity of glutathione peroxidase. In conclusion, the determination of the mentioned markers in hospitalized senile patients as an adjunct to the routine assessment of nutritional status might be suggested to identify the early risk of malnutrition so that a personalized nutritional therapy can be implemented as early as possible.
Collapse
|
13
|
Tuft C, Matar E, Menczel Schrire Z, Grunstein RR, Yee BJ, Hoyos CM. Current Insights into the Risks of Using Melatonin as a Treatment for Sleep Disorders in Older Adults. Clin Interv Aging 2023; 18:49-59. [PMID: 36660543 PMCID: PMC9842516 DOI: 10.2147/cia.s361519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Exogenous melatonin is commonly used for sleep disorders in older adults, and its use is increasing over time. It appears to have modest efficacy in treating insomnia and circadian rhythm sleep-wake disorders. Melatonin is commonly perceived to be a safe alternative to other hypnotics and is available without prescription in some jurisdictions. New evidence suggests that endogenous melatonin has pleomorphic effects on multiple organ systems, many of which are poorly understood. This narrative review summarizes the current evidence regarding the safety of melatonin in older adults (defined by age over 65 years). Melatonin appears to have a favorable safety profile in this population, however there is a dearth of evidence regarding the safety of prolonged use. There are several factors which increase the risk of adverse effects of melatonin in older adults, and these should be taken into consideration when prescribing to this population.
Collapse
Affiliation(s)
- Colin Tuft
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Elie Matar
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia
| | - Zoe Menczel Schrire
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Brendon J Yee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia,School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia,Correspondence: Camilla M Hoyos, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia, Tel +61 2 9114 0409, Email
| |
Collapse
|
14
|
Dörks M, Hoffmann F, Jobski K. Antidepressant drug use and regional prescribing patterns in Germany: results from a large population-based study. Int Clin Psychopharmacol 2022; 37:185-192. [PMID: 35143440 DOI: 10.1097/yic.0000000000000393] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To consider antidepressant prescribing on a population level with a focus on regional prescribing patterns in Germany. BASIC METHODS Based on data from about 70 million individuals covered by all statutory health insurance funds in Germany in 2010, the prevalence of antidepressant use (overall, for drug classes and individual drugs) was calculated stratified by age and sex. Regional analyses were performed on a state and also on a district level. MAIN RESULTS The study population comprised 68 427 464 (female: 53.0%) persons, of which 5 052 293 (7.4%) were prescribed at least one antidepressant. The most frequently prescribed drug class was tricyclic antidepressants whereas on a substance level citalopram was most commonly used. Antidepressant prescribing was lowest in children and adolescents (0.2%) and most common in persons aged 70 years and older (13.4%). Women more often received antidepressants than men (9.7% vs. 4.8%). Prevalence of antidepressant use varied between 8.7% (Saarland) and 6.3% (Saxony-Anhalt) and was generally highest in the southwestern and lowest in the eastern states. Accordingly, districts with the highest prevalence were located in the southwestern states. PRINCIPAL CONCLUSIONS Antidepressant use in Germany varied considerably by age and sex and also on a state and district level.
Collapse
Affiliation(s)
- Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | | | | |
Collapse
|
15
|
Nasser A. Antidepressant’s long-term effect on cognitive performance and cardiovascular system. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.23.7688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: The nature of antidepressants and their adverse effects should be considered when treating severe depression in individuals with psychotic symptoms. Antidepressant prescription rates have risen steadily over the last 30 years, affecting people of all ages. Aim: The goal of this study was to see if depression and antidepressant usage were linked to long-term changes in cognitive function and cardiovascular health. Methodology: Meta-analysis was performed using PRISMA guidelines along with using the SPIDER search framework using related keywords on different search engines i.e. Google scholars, PubMed, Scopus, ISI, etc. Total (n=2256) papers were obtained and assessed for eligibility. Altogether 15 studies were included using databases and other methods. The Newcastle-Ottawa Scale examined the grades provided by the data after numerous screenings. Result: A distinct link was found between antidepressants with cognitive performance and the cardiovascular system. Dementia and hypertension were prevailing long-term effects caused by frequent use of antidepressants in chronic and mild depression.
Collapse
|
16
|
Li M, Ao Y, Deng S, Peng P, Chen S, Wang T, Martek I, Bahmani H. A Scoping Literature Review of Rural Institutional Elder Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610319. [PMID: 36011954 PMCID: PMC9408389 DOI: 10.3390/ijerph191610319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 05/31/2023]
Abstract
Under circumstances of pervasive global aging combined with weakened traditional family elder care, an incremental demand for institutional elder care is generated. This has led to a surge in research regarding institutional elder care. Rural residents' institutional elder care is receiving more attention as a major theme in social sciences and humanities research. Based on 94 articles related to rural institutional elder care, this study identified the most influential articles, journals and countries in rural institutional elder care research since 1995. This was done using science mapping methods through a three-step workflow consisting of bibliometric retrieval, scoping analysis and qualitative discussion. Keywords revealed five research mainstreams in this field: (1) the cognition and mental state of aged populations, (2) the nursing quality and service supply of aged care institutions, (3) the aged care management systems' establishment and improvements, (4) the risk factors of admission and discharge of aged care institutions, and (5) deathbed matters regarding the aged population. A qualitative discussion is also provided for 39 urban and rural comparative research papers and 55 pure rural research papers, summarizing the current research progress status regarding institutional elder care systems in rural areas. Gaps within existing research are also identified to indicate future research trends (such as the multi-dimensional and in-depth comparative research on institutional elder care, new rural institutional elder care model and technology, and correlative policy planning and development), which provides a multi-disciplinary guide for future research.
Collapse
Affiliation(s)
- Mingyang Li
- College of Management Science, Chengdu University of Technology, Chengdu 610059, China
| | - Yibin Ao
- College of Management Science, Chengdu University of Technology, Chengdu 610059, China
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
| | - Shulin Deng
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
| | - Panyu Peng
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
| | - Shuangzhou Chen
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Tong Wang
- Faculty of Architecture and Built Environment, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Igor Martek
- School of Architecture and Built Environment, Deakin University, Geelong 3220, Australia
| | - Homa Bahmani
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
| |
Collapse
|
17
|
Prevalence, progress, and subgroup disparities in pharmacological antidepressant treatment of those who screen positive for depressive symptoms: A repetitive cross-sectional study in 19 European countries. Lancet Reg Health Eur 2022; 17:100368. [PMID: 35373171 PMCID: PMC8969158 DOI: 10.1016/j.lanepe.2022.100368] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background The European Mental Health Action Plan (EMHAP) 2013–2020 promoted community-based mental health services. One potential success indicator is the provision of antidepressant medication to those needing it. Methods Public data from two surveys (Health Survey for England, UK; Survey of Health, Ageing and Retirement in Europe) covered 19 European countries across EMHAP phases one (2011–2015) and two (2015–2018). People screening positive for depressive symptoms by self-report were included. The primary outcome was antidepressant use: using country-specific weighted regression models, we estimated temporal trends and subgroup disparities in antidepressant receipt, with secondary analysis by country-level measures including healthcare expenditure. Findings Across 37,250 participants, after controlling for age, sex, wealth, and physical disability, antidepressant use (amongst those screening positive) increased significantly in 14/19 countries, with the smallest increase being in Slovenia (adjusted OR[AOR] for trend=1.68[1.20–2.36]) and the highest increase being in Germany (AOR for trend=10.07[7.54–13.46]) and Austria (AOR for trend=10.07[7.32–13.74]). The overall proportion using antidepressants was positively associated with national health expenditure (coefficient=5.43[1.62–9.25]), but not with gross national income per capita or the number of psychiatrists, general practitioners, or psychiatric hospital beds. In 15/19 countries, antidepressants were used less by ≥65-year-olds than 50–64-year-olds, with the smallest differential reported in Luxembourg (AOR=0.70[0.49, 0.98]) and the highest in Germany (AOR=0.28[0.21, 0.37]); this disparity widened in 12/15 countries. Men used antidepressants less than women in 8/19 countries, across phases. In 13/19 countries, people with physical disability were more likely to receive antidepressants, with the smallest gap in Italy (AOR=1.42[1.12–1.80]) and the largest in Israel (AOR=2.34[1.46–3.74]); this disparity narrowed in 5/13 countries. Disparity by wealth was found in 8/19 countries, but its temporal trend varied. Interpretation Usage of antidepressants by those with depressive symptoms has increased, with wide variation between countries and subgroups. Disparities across age, sex, and disability should prompt further research. Funding Medical Research Council (grants MC_PC_17213 and MR/W014386/1), UK National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, NIHR Cambridge Biomedical Research Centre (BRC-1215-20014).
Collapse
|
18
|
Rabin EE, Kim M, Mozny A, Cardoza K, Bell AC, Zhai L, Bommi P, Lauing KL, King AL, Armstrong TS, Walunas TL, Fang D, Roy I, Peipert JD, Sieg E, Mi X, Amidei C, Lukas RV, Wainwright DA. A systematic review of pharmacologic treatment efficacy for depression in older patients with cancer. Brain Behav Immun Health 2022; 21:100449. [PMID: 35368609 PMCID: PMC8968450 DOI: 10.1016/j.bbih.2022.100449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 12/19/2022] Open
|
19
|
Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Impact of medication reviews on potentially inappropriate medications and associated costs among older women in aged care. Res Social Adm Pharm 2022; 18:3758-3765. [DOI: 10.1016/j.sapharm.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/04/2022] [Accepted: 05/07/2022] [Indexed: 12/01/2022]
|
20
|
Hedna K, Fastbom J, Jonson M, Wilhelmson K, Waern M. Psychoactive medication use and risk of suicide in long-term care facility residents. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5684. [PMID: 35142388 PMCID: PMC9306521 DOI: 10.1002/gps.5684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate psychoactive medication use and risk of suicide in long-term care facility (LTCF) residents aged 75 and above. A second aim was to investigate the role of psychiatric and medical conditions in the occurrence of suicide in LTCF residents. METHODS A Swedish national register-based cohort study of LTFC residents aged ≥75 years between 1 January 2008 and 31 December 2015, and followed until 31 December 2016 (N = 288,305). Fine and Gray regression models were used to analyse associations with suicide. RESULTS The study identified 110 suicides (15.8 per 100,000 person-years). Half of these occurred during the first year of residence. Overall, 54% of those who died by suicide were on hypnotics and 45% were on antidepressants. Adjusted sub-hazard ratio (aSHR) for suicide was decreased in those who were on antidepressants (aSHR 0.64, 95% confidence interval 0.42-0.97), even after the exclusion of residents who had healthcare contacts for dementia or were on anti-dementia drugs. The aSHR for suicide was more than two-fold higher in those who were on hypnotics (2.20, 1.46-3.31). Suicide risk was particularly elevated in those with an episode of self-harm prior to LTCF admittance (15.78, 10.01-24.87). Specialized care for depression was associated with increased risk, while medical morbidity was not. CONCLUSIONS A lower risk of suicide in LTCF residents was found in users of antidepressants, while elevated risk was observed in those on hypnotics. Our findings suggest that more can be done to prevent suicide in this setting.
Collapse
Affiliation(s)
- Khedidja Hedna
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Statistikkonsulterna ABGothenburgSweden
| | - Johan Fastbom
- Aging Research CenterKarolinska Institute and Stockholm UniversityStockholmSweden
| | - Mattias Jonson
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Neuropsychiatric Epidemiology Unit, Department of Psychiatry and NeurochemistrySahlgrenska Academy, University of GothenburgGothenburgSweden,Affective ClinicRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Katarina Wilhelmson
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Department of Health and RehabilitationInstitute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden,Department of Acute Medicine and GeriatricsRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Margda Waern
- AgeCap Center, Department of Psychiatry and NeurochemistryGothenburg UniversityGothenburgSweden,Psychosis ClinicRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| |
Collapse
|
21
|
Geriatric Depression and Inappropriate Medication: Benefits of Interprofessional Team Cooperation in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312438. [PMID: 34886164 PMCID: PMC8657238 DOI: 10.3390/ijerph182312438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
An investigation of inappropriate medication use in treatment of depressivity in institutionalized older adults, based on a nurse-led evaluation of functional status and depressive symptoms in nursing home residents. Methods: A cross-sectional multicenter study was performed using records from 1087 residents cared for in fifteen nursing homes (NHs) in the Czech Republic. Inclusion criteria were being a permanent resident of one of the facilities, being 60 years of age or older, having a Geriatric Depression Scale score of 6 or more, and having a Mini Mental State examination score 10 or more. The final sample for analysis included 317 depressed NH residents. Results: 52 percent of NH residents with depressivity had no antidepressant treatment. Benzodiazepines were the only medication in 16 percent of depressed residents, and were added to antidepressant treatment in 18 percent of residents. Benzodiazepine users had significantly higher GDS scores compared to non-users (p = 0.007). Conclusion: More than half of depressed NH residents remained without antidepressant treatment. Residents inappropriately treated with benzodiazepines were more depressed than residents treated with antidepressants only, or even not treated at all. Cooperation of the interprofessional team in the screening of depressive symptoms has the potential to improve the quality of care.
Collapse
|
22
|
Over the top: psychotropic polypharmacy in long-term care. Int Psychogeriatr 2021; 33:1015-1017. [PMID: 34726146 DOI: 10.1017/s1041610221000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|